Sedationagitation

Sedation-agitation refers to the spectrum of a patient’s mental state observed in clinical settings as they move from deep sedation to agitation, most commonly in critical care and anesthesia. Effective management aims to provide comfort and analgesia while preserving safety and the ability to participate in care and neurologic assessment. The approach relies on regular assessment and titration of sedation and analgesia to achieve appropriate target levels.

Assessment and monitoring often use standardized scales such as the Sedation-Agitation Scale (SAS), the Richmond Agitation-Sedation Scale (RASS), and other validated tools. These measures help guide dosing, prevent oversedation or undersedation, and support daily evaluation of sedation adequacy, including opportunities for spontaneous breathing trials in ventilated patients.

Management strategies emphasize a balance between comfort and safety. An analgesia-first approach is common, with decisions about sedative depth guided by objective scales. Daily interruption of sedation when feasible, and nonpharmacologic measures such as sleep optimization and environmental modification, are also encouraged. Pharmacologic options include opioids for analgesia and sedatives such as propofol, benzodiazepines, or alpha-2 agonists (for example, dexmedetomidine). Dexmedetomidine is often favored when lighter sedation and reduced delirium risk are desirable, though selection depends on patient status and goals.

Risks of poor management include oversedation, which can prolong mechanical ventilation and ICU stay, and agitation, which increases the risk of self-extubation or device removal. Delirium is a common complication associated with worse outcomes. Proper sedation-agitation management seeks to optimize comfort, safety, and recovery.